by Tom Brokaw
Dr. Majka, standing behind him, was quiet, but I could see the concern in his expression. When he was first assigned to me several years ago, I learned that he was born in Buffalo, New York, and grew up in the area, beloved home of my late colleague Tim Russert, the legendary Meet the Press host and Buffalo’s leading cheerleader. When I mentioned that he said, “Oh, I know. The two worst things for Buffalo were losing Tim and wide right in ninety-one,” the year the bad-luck Buffalo Bills lost the Super Bowl to the New York Giants on a missed field goal from twenty-nine yards out with just eight seconds left in the game.
Dr. Majka and I developed a bond from that moment on, also sharing a passion for pheasant hunting and fishing. He’s an enthusiastic angler for walleye, the feisty and very tasty game fish of the upper Midwest. Fishing for walleye in Minnesota lakes is the upper Midwest equivalent of a religious pilgrimage.
No talk of hunting and fishing in this meeting, however. The quality of life during treatment? Uneven. Cause? Unknown.
I had often wondered how I would react to this kind of news. Don’t we all.
Now I know. Family first.
Our family had just finished some estate planning and financial evaluations. My earning years might be greatly reduced, but there’s enough to get through this and keep the family commitments. As a working-class kid who found success in a profession that paid some big numbers, I am always of two minds: Yes, we live very well and I like that. I don’t want money to define who we are, but with this news I was happy to have its company.
I worried my Irish gene might kick in and I would tear up at the news—the maternal side of the family are Conleys, originally from County Mayo—but I was surprisingly focused on the practical questions, not the personal worries. I did not have an “Oh, my god, I’m gonna die” moment. Not one, somewhat to my surprise. I later did remember Bill Paley’s lament in his nineties, “Do I HAVE to die?” Paley was used to having everything his way—CBS, great wealth, world-class art, women, power—so his question was understandable. I was more in the spirit of my friend Jim Harrison, the writer who manages to be at once gruffly verbose and quietly insightful. We’re the same age, and in an essay on his mortality he wrote, “As I aged, I expected to think about death far more than I do,” explaining that after some severe health issues he’s determined to go out with a bang—writing harder, fishing harder, and treating three-a-day naps as a Buddhist Noble Truth. That was a truth I came to treasure.
There were those fleeting moments of wondering, Is this payback for having a good life, despite imperfect behavior and decisions from time to time? Retribution from whoever or whatever has the power I keep hearing those television preachers invoke?
Over the years friends have often referred to “Brokaw’s lucky star.” I’d have to reach them and say, “Turns out that star has a dimmer switch.”
Those were the random thoughts that appeared and disappeared just as swiftly as I tried vainly to understand this alien invasion of my bone marrow. Life has built-in risk and reward rhythms and the human body, that complex construct of brain cells, blood cells, bones, organs, nerves, and dermatology, is a biological marvel until it turns on you, and if you give it enough time, it will—dammit.
I had more immediate concerns: how to tell Meredith, still in Montana, when I have more tests and a board meeting the next day. I have a script for JFK that needs work.
As Majka and Gertz left I kept plumbing my reaction. Did they just say I have a form of incurable cancer? There had been no advance signals that something was wrong, apart from that persistent back pain, which I attributed to the two falls I’d taken while fishing and the long airplane rides to and from Africa.
(At one point earlier in the year I had even consulted a Montana chiropractor highly regarded for dealing with cowboy and skier back issues. I suspected he’d be surprised to hear the real villain is cancer.)
It was a left brain—right brain exercise as I tried to work through the consequences of this startling and wholly unexpected news.
Left brain: I’ve got to get back to the hotel room and finish rewriting that documentary.
Right brain: C’mon, this doesn’t happen to me. At NBC I am jokingly called Duncan the Wonder Horse for my ability to juggle many projects at once and still indulge my passion for the outdoors. Does this mean no pheasant hunting in South Dakota this fall? No bike trip to Australia in the spring?
At the time of the diagnosis I was, at seventy-three, just short of the life expectancy of an American white male. That statistic has percolated up to almost seventy-six years.
Seventy-six for an American male was a number on an actuarial chart that includes men who are obese, smokers, and inheritors of deadly family genes. I took my guidance from more than a few friends still going strong in their eighties or even nineties. Life expectancy was not so much a measure of how long I had to live but, rather, what was still to be accomplished.
Is it too late to learn to sail solo? Play chess? Get a short story published?
Most of all, I’ve had a life rich in personal and professional rewards beyond what should be anyone’s even exaggerated expectations. I fully expect it to go on not because I want to write more books or appear on television more. I want more time with our family and in a contemplative, reflective environment. This will force the issue. Time to stop running for the plane and time to reorder priorities. Is that possible given the momentum of my life up to this point? I’ll have some help from the next generation.
The Brokaw grandchildren bring all of that into sharp focus. Two teenage girls, two elementary school girls, and a new addition: a boy, born recently to our youngest, who picked out a sperm donor and delivered an irresistible child perfectly reflecting his American and Chinese ancestry.
As parents we are so consumed with the new experience of first having and then raising children, we often miss or rush through their unique stages of development. As grandparents we have the time and the eye for appreciating their physical, intellectual, and personality changes.
I don’t want to give up my front-row seat for one of life’s most rewarding experiences, the coming of age of Claire and Meredith, Vivian and Charlotte, and their prince, Archer.
In the meantime, Meredith: How do I break the news to her? We have been married for fifty-one years. I don’t want to tell her on the telephone. I’ll have to live with this for forty-eight hours and then deal with it when I return to the ranch. Not going to be easy.
As I made my way back to the hotel I kept checking my emotions. No “Why me, God?” I’m still a lucky guy. I have the best medical care. We caught it early. Unfairly or not, I have access to whatever resources I need.
I was a little surprised by the calmness I felt as I walked across one of the sky bridges connecting downtown Rochester and the hospital complex. In retrospect, it was a by-product of ignorance. For me, the diagnosis was at the beginning a bewildering intrusion that I didn’t fully appreciate. I could not anticipate how completely cancer would take over my life, how my body and psyche would change. It was already attacking my healthy cells and bones, drilling a hole in my right pelvis, but apart from that persistent backache I had no physical sense of the gravity of the situation. It seemed somehow abstract, a series of numbers on a computer screen unrelated to my anatomy.
I stumbled emotionally for a moment. That morning a young IBM representative had interrupted my coffee to share his memories of growing up in Yankton, my hometown. His father had worked for my dad on a large dam outside of town, building and maintaining recreation areas. He said, “In our family we thought your parents were simply the best,” adding with a laugh, “I delivered the newspaper to their house and your mother was always completely paid up.”
Mother and Dad are both gone, but their reputation and legacy live on.
Dr. Majka called to confirm the next morning’s appointment and to say, “I have to tell you I came home and spent a lot of time reviewing how we reached the diagnosis. I couldn’t believe this
has happened to you.”
He wasn’t foretelling my death. He simply projected how my adventurous life would be curtailed. I was touched but told him I was handling it well and appreciated his early detective work that led to the diagnosis.
Later, Dr. Gertz said, “Andy is the best. He’s an internal medicine guy and there’s a thousand ways he could have read those blood numbers but he nailed it.”
Andrew, always modest, explained to me that the greatest challenge for a physician is what he calls “evidence-based medicine,” EBM, in which a physician relies on a large body of statistics. Instead, he says, let the evidence presented by the patient sitting before you lead you to a conclusion, and resist a diagnosis based primarily on a mass of numbers.
Although at first he thought I had an internal hematoma from the falls while fishing, he kept connecting the dots and had come to the conclusion that it was multiple myeloma. Without his timely analysis I would have returned to Montana, still complaining of back pain brought on by two compression fractures in my lower back, beyond the scope of a conventional X ray.
I’ve now talked to two prominent physicians who have MM but whose diagnoses were delayed because they interpreted their back pain as the result of aging athleticism. Their orthopedists agreed. Months went by before they got the blood profile that confirmed the real villain.
Dr. Jo A. Hannafin, a top surgeon and director of orthopedic research at the Hospital for Special Surgery in New York, knew instantly she might be an MM victim. During surgery she lowered her head and felt a bone snap in her neck.
It could not have been that she was out of shape. In addition to her MD and PhD she is the first woman elected president of the American Orthopaedic Society for Sports Medicine, testimony to her wide-ranging research on athletic injuries, her skills in the operating room, and her record as a three-time national rowing champion.
MM is a low-population cancer, according to the official statistics, but I told Dr. Hannafin that I kept running into people—mostly male—who shared the condition. One MM patient even showed up in the outdoor plaza when I was doing the Today show with a sign: “Mr. Brokaw—I have multiple myeloma, too.” We talked about our common condition and different treatments.
“When I was a resident,” Dr. Hannafin told me, “if someone came in with compression fractures in their bones it was likely an African American male in their sixties. Now it is often a male or female up and down the age scale.”
She was diagnosed about four months earlier than I and elected to have a stem cell transplant when drugs alone didn’t get her numbers back to normal. It was not easy. She was in the hospital seventeen days and confined to her home for weeks, battling fatigue and weight gain, a new experience for this world-class athlete.
Now she’s back to her old regimen, bicycling 162 miles in two days for an MM research benefit. “Finishing that was quite emotional,” she said, adding, “I only think about myeloma when I can’t do what I used to take for granted.” I am silently determined to match her bike ride at the same stage in my recovery.
As a physician, Hannafin thinks she’s a better communicator now that she’s had both experiences, those of healer and patient. “I write down a lot more for patients than I did in the past.”
Dr. Hannafin’s experience as a patient and as a physician is not unusual for cancer victims. Cancer of whatever flavor triggers a reflective gene: Just let me live and I will learn to be a better person. In the past when I’d be at an event for cancer research and cancer survivors were asked to stand I’d be surprised by how many were in the room, but there my curiosity would end. Now when I meet a cancer survivor I want to know, “What kind? Where were you treated? How has your life changed?”
It is a club, a bond built on survival and the common anxiety of having your body turn on you in such a vicious way.
This was all new to me that humid Minnesota Thursday night in August. I wasn’t in denial, but neither was I fully comprehending the radical change about to descend on me.
I decided the JFK script would be the best distraction and so I skipped the regular Thursday night board dinner and went to the computer, dividing my attention between “What do we know about Kennedy now that we didn’t know then?” and “Does this mean radiation or chemo? Rochester, or can I be treated in New York?”
I needed to know more about this alien invasion of bone marrow. Google “multiple myeloma” and there it is: Plasma cells that help you fight infections become cancerous and multiply at dangerous rates, affecting bone strength, kidney function, energy. In short, in multiple myeloma good blood cells become bad cells and no one yet knows why.
The median age for onset is sixty-five. Men are more susceptible than women and African Americans are twice as likely as whites to get the disease.
It represents a small part of the cancer universe, affecting only about 1 percent of the people who get the disease.
That’s as much as I wanted to know that night. I needed to get some sleep, and the more I knew about my new condition, the smaller the chance I would rest easy.
I wouldn’t find a cure or even much more relief in the Google universe. There will be more questions, many more, tomorrow and beyond.
The phone rang. A fellow trustee and friend so close we might as well be brothers called to ask, “Where are you? Is something up?”
Ron Olson, the uberlawyer for Warren Buffett and various major corporate interests, intuitively knew that my absence from the trustees’ dinner meant something was amiss.
I said, “Meet downstairs for a martini.” Actually, we had one and a half as I explained what I knew. Since we share lifestyles, family values, physical activities, and, most of all, life stories, I could tell he was computing what this surprising, even shocking, news meant.
We both grew up in small midwestern towns, married very gifted local women, caught the brass ring in our professions, and never quite got over all the good fortune that came our way. I asked Ron to keep it to himself until I knew more. I did not want to become a photo on the Internet: Tom Brokaw, cancer victim. That was the beginning of a dual ordeal: how to find out more about the progress of the disease and settle on a treatment while keeping the news confined to family and a very few who would need to know.
I made it through the evening and the next morning’s board meeting, but I cannot say I was single-minded. As everyone left for the airport, I stayed behind for the mixed news from Dr. Gertz. He was right about the overall diagnosis, but his worries about the upper spine being involved were misplaced. It is multiple myeloma, he said, adding, “Eight years.” I didn’t blink but quickly asked, “Eight years and out?”
“Yes,” he said, “but that’s the current estimate for your condition. There’s been great progress in treating this. We’ve learned fifty percent more than we knew before. People are living with this well beyond the estimates.
“We need a more complete look,” he explained. “Do you have time for an MRI?” He wanted me to undergo the magnetic resonance imaging that requires full-body immersion in a high-tech cylinder.
I am told many patients are claustrophobically uncomfortable with MRIs. I usually like the isolation and the opportunity to nod off. Not this time. By late Friday afternoon the clinic is mostly deserted after a hectic five-day schedule, so I was alone with two pleasant technicians, encased for an hour with the eerie electronic sounds of the MRI tube, rehearsing what I would say to Meredith when I returned to Montana later that night.
Who else needs to know? Family, especially Jennifer, our physician daughter; NBC’s senior management, my bosses. By the end of the hour my normal “bring it on” self-confidence was weakened a bit, not helped by the lonely, utterly clinical setting in which I found myself.
An MRI is a cacophony of weird electronic sounds echoing through a narrow steel tube as you slide back and forth slightly for a series of scans. Click. Buzz. What is it seeing? Are those rogue blood cells like the old Pac-Man monsters, eating up the good cells?
After an hour I had second thoughts about my ease with the procedure. It did give me time to think about my new life and how I might deal with it. As a journalist I immediately thought of keeping a journal, which led to this book, and the occasional reporter’s notebook shorthand of MM for multiple myeloma.
Before the MRI I had scrambled to find a plane back to Montana. A usually reliable charter operator signed up and then fumbled the scheduling, so I would be getting home late and in a slower, uncomfortable prop aircraft. It was a long ride through the dark of a prairie night as we crossed out of Minnesota and into North Dakota before Montana was below. Big Sky country up on the northern latitudes, a muscular tapestry of geography still not completely tamed two hundred years after Lewis and Clark pushed through its mountains and rivers, the grasslands and forests, in search of a passage to the Pacific.
A midnight arrival at the small, deserted Livingston, Montana, airport was the beginning of the next difficult passage: when exactly to tell Meredith, who was waiting with another member of the family, our Labrador retriever, Red. A darkened car on a dangerous road was not a good place to break the news that would change her life as well. On the long eighteen-mile drive on a twisting gravel road to the ranch I kept up a steady stream of gossip from the Mayo board meeting and asked about some ranch issues.
In the small upstairs bedroom of our modest ranch house I made a drink—Scotch on the rocks—showered, sat on the edge of the bed, and said, “There’s something I didn’t tell you.” I took her through the persistent back pain, the orthopedic optimism, and then the unexpected visit from Doctors Majka and Gertz.
